Scripted

después del examen con el paciente

Paciente: ¿Por qué no puedo ver bien?

Doctora: El problema es que usted tiene cataratas, muy densas. Esta es la razón por qué no podemos mejorar la visión con un cambio en los lentes.

P: ¿Qué es lo que puedo hacer ahora?

D: Si fueran mis ojos, querría la cirugía para sacar las cataratas. Usted tiene una retina saludable- no hay una razón por qué no verá una perfecta 20/20 después de la cirugía.

P: Sí, estoy de acuerdo. Dime más información de la cirugía-

D: Bueno, si decide tener la cirugía, tiene que regresar aquí para una cita con el cirujano. Él necesita hacer otras medidas del ojo para determinar cual implante se requiere después de que él quita el cristalino natural.

P: ¿Qué --------------------------cirugía----------------tiempo---?

D: (¿Qué exactamente él me dijo? Me preguntó algo del tiempo de la cirugía—¿Cuánto tiempo para hacer las medidas y escoger una fecha para el procedimiento? ¿Cuánto tiempo dura el procedimiento actual? ¿Cuánto tiempo se necesita para recuperar y regresar a las actividades cotidianas? No estoy segura de que fuera la pregunta. ¡Ahora tengo que contestar todas las posibilidades!)

Bueno, si decide seguir con la cirugía, el próximo paso es que tiene que hacer una cita con el cirujano. Él va a hacer medidas del ojo para determinar el poder y el tipo de implante ocular que necesita después de le ha sacado la catarata. Generalmente, el horario de cirugía es abierto. Puede tener el procedimiento en las próximas semanas.

En el día de la cirugía, usted llega al hospital por la mañana. No se requiere anestesia general, solo anestesia tópica. El procedimiento dura 10-15 minutos. Inmediatamente después, cuando usted se levanta de la mesa quirúrgica, usted se da cuenta de que ve mucho más claro que antes.  En la sala de recuperación, las enfermeras le dan las instrucciones para el cuidado del ojo con antibióticos y medicamentos antiinflamatorios, y también la fecha de la cita para su primera visita postoperatoria. Resumiendo, usted va a pasar en total 4-5 horas en el hospital el día de la cirugía: de la hora de llegada al fin de la recuperación después del procedimiento.

Durante la primera semana después de la cirugía, se le equipa con una protección ocular cuando duerme. Pero, generalmente otro que eso, se permite que usted vuelve a su rutina diaria, sin restricciones, casi inmediatamente después de la primera visita postoperatoria.

P:Ajj-esa fue mi pregunta. No puedo perder más días del trabajo que son necesarios para la recuperación.

(Supongo que estaría más fácil, la próxima vez ,le preguntar al paciente para repetir su pregunta, en lugar de “adivinar” lo que quiera del principio. Es solo que, no quiero mostrar al paciente  que mi entendimiento del idioma de español no es completo. No quiero que el paciente pierda la confianza en mí. Como te he dicho muchas veces antes, no quiero aparecer como tonta cuando hablo el idioma. Trabajo muy duro para hablar en una manera natural, sin fuerza.  Tengo que conformarme al idea de que voy a preguntar para ayuda o para una explicación cuando se necesite. En este caso, habría salvado tiempo precioso en mi explicación si hubiera comprendido la pregunta en primer lugar. Ahora, la hago una lección para mí y para todos ustedes para referencia futura.)

                                                                          *

after the exam with the patient

Patient: Why can’t I see well?

Doctor: The problem is that you have very dense cataracts.  This is the reason why we cannot improve the vision with a change in the eyeglasses.

P: What can I do now?

D: If it were my eyes, I would want surgery to remove the cataracts.  You have a healthy retina – there is no reason why you will not be able to see a perfect 20/20 after the surgery.

P: Yes, I agree.  Give me more information about the surgery.

D: Well, if you decide to have the surgery, you have to return here for an appointment with the surgeon.  He needs to do other measurements of the eye in order to determine which implant is needed after he removes the natural crystalline lens.

P: What-------------------------surgery------------------time---?

D: (What exactly did he ask me? He asked me something about the time of the surgery—How much time to do the measurements and choose a date for the procedure? How much time does the actual procedure last? How much time is required for recuperation and a return to normal daily activities? I am not sure what the question was.  Now I have to answer all the possibilities!)

Well, if you decide to go ahead with the surgery, the next step is that you have to make an appointment with the surgeon.  He  is going to do measurements of the eye to determine the power and type of ocular implant you will need after he has removed the cataract.  Generally, the surgical schedule is open.  You can have the procedure in the upcoming weeks.

On the day of the surgery, you arrive at the hospital in the morning. General anesthesia is not required, only topical anesthesia.  The procedure lasts 10-15 minutes.  Immediately after, when you get up off the surgical table, you realize that you see much more clearly than before.  In the recovery room, the nurses give you instructions for the care of the eye with antibiotics and anti-inflammatory medication, and also the date of the appointment for you first post-operative visit.  In summary, you are going to spend in total 4-5 hours in the hospital on the day of the surgery: from the arrival time to the end of the recovery period after the surgery. 

During the first week after the surgery, you are given an ocular shield to wear when you sleep.  But generally other than this, you are permitted to return to your daily routine, without restrictions, almost immediately after the first post-operative visit.

P: Ahh—THAT was my question.  I can’t lose any more work days than are necessary for the recovery period.

(I suppose it would be easier, the next time, to ask the patient to repeat his question, instead of “guessing” what he wanted in the first place.  It is only that, I don’t want to show the patient that my understanding of the Spanish language is not complete.  I don’t want the patient to lose confidence in me.  Like I have said to you many times before, I do not want to appear foolish when I speak the language.  I work hard to speak in a natural way, without forcing (my words). I have to get used to the idea that I am going to ask for help or for an explanation when it is needed.  In this case, I would have saved precious time in my explanation if I had understood the question to begin with.  Now, I make it a lesson for me and for all of you for future reference.)

Preferred language

Yesterday, before I called a patient into my office to begin the eye exam, I looked over the intake forms he filled out. Under the section where it said “preferred language”, he had checked “Spanish”. So, when I went to collect him from the waiting area, I greeted  him in Spanish. I brought him to the exam room and had him sit down. I started my usual Spanish dialogue of, “Está aquí por un examen completo de los ojos. La enfermera escribió aquí que necesita usted lentes nuevos, particularmente para leer, y también que tiene un diagnóstico de la diabetes, y necesita un examen de la retina,” and so on and so on. He answered me in English, “Yeah, my glasses are two years old and I need new ones. My doctor wanted an exam of the eyes because of the diabetes.”

His English was good and he continued speaking it, so I changed to English and onward the exam went. But I wondered, why did he start speaking English at all? Especially when he had checked off that his preferred language was Spanish? It’s not like he spoke in English to everyone else in the office. After I finished the exam and he brought the coding sheet out to the front desk to schedule his next appointment, I could hear him talking and joking in Spanish to the front office staff, who happen to be Latinas from the Dominican Republic.

This situation has been happening more often lately, and it just has me thinking, why? Is it because I’m a doctor, and these patients want to show someone who they perceive to be an authority figure that they are capable of conversing in either language?

Is it because they see me, a non-Latino person, speaking very good but not perfect Spanish, and would rather communicate with me in what they assume is my native English?

Is it due to the recent political climate--the random deportations of illegal immigrants--creating a fear in these patients that they feel the need to show that they do speak English well, and are a permanent part of American society?

Is it simply that they want to flex their English-speaking muscles, while I flex mine in Spanish?

I turned to a simple, but sometimes vacuous source for more information: Google. I searched, “Spanish-speaking patients who feel the need to speak English at the doctor’s office”, or something along those lines. Not many relevant hits came up.  The closest situation was one where a man, who was learning Spanish, described his frustration that every time he would try and practice his Spanish with Latino restaurant workers, they always answered him in English. Someone angrily answered his query, saying that it’s rude and racist to assume that just because someone is Latino, that he automatically should speak and be spoken to in Spanish. Well, I can just as quickly say, don’t assume just because someone is non-Latino that he doesn’t speak Spanish. You may find out quite readily that he does, if you give him a chance to speak.

I grew up in the 1980s. Back then, you could honestly and innocently do something or say something, without the observer or listener automatically assuming that you had racist or malintent.  What is so wrong with encountering a person, hearing that she has a heavy Spanish accent, and trying to converse in Spanish with that person? Is that racist?

 Nelson Mandela once said, “If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.”

Therefore, can’t it simply be that you are trying to make a more personal connection with that individual, by speaking in his native language? In my particular situation, I work as an ophthalmologist in an office in the northeastern United States. It happens to be situated in a community of mostly Spanish-speaking people, many of whom who only emigrated to the US within the last few years. That being said, I do not go out into the waiting area and start speaking Spanish when I see a Latino patient. At the same time, there have been many Latino patients I approach greeting them in English, and they give me the look of any person who does not understand spoken English: one of confusion, dismay, even fear. I don’t want dismay and fear to be the first impressions that a patient has when coming to my office. I don’t want the patients to think that they will have a language barrier with their doctor, and therefore will not get the help they came to receive.

So, I look to the intake forms. If someone marks off Spanish as preferred language, I greet her in Spanish. I allow the patient to choose to either continue in Spanish or not. If she continues in English, then I will follow her lead. If I happen to greet a patient in English who indicates preferred language as English, but I see right away that he is having trouble understanding and/or communicating with me, I’ll ask,

“¿Qué es lo que prefiere usted—inglés o español?

and if he says,

“Prefiero español, gracias.”, then so be it, and onward the conversation takes place.

I’m very flexible as far as the way I run my practice. The goal of any doctor –patient dialogue is clear communication. The language choice is simply a means to an end, and shouldn’t mark the end of meaningful conversation.

Death Valley National Park 2016

  

Una conversación con un paciente

Doctora: (al mostrar a la paciente y a su hijo al cuarto) Por favor, siéntese ahí, (mira el hijo) y hay una silla para usted en el lado.

Paciente+hijo: gracias.

D: Ok, leí la información que trayó – sus antecedentes medicos – esta información me ayuda saber la historia de sus ojos y el cuidado –lo que proveía su medico en Puerto Rico.

P: De nada.

D: Veo aquí que usted recibió un diagnóstico de glaucoma hace algunos años ahora, y que está utilizando la gota latanoprost – una gota cada ojo por la noche.

P: Sí. One drop in each eye at night.

D: Bueno, la presión hoy es alta- 25,26-necesito revisar la presión con esta máquina, la lámpara de hendidura- es el estándar dorado para revisar la presión del globo del ojo.

Hijo a la madre: Ella quiere revisar la presión con—

P al hijo: Sí, la entiendo. I understand.

D (hace el examen, revisa la presión y el nervio óptico, acaba el examen y da vuelta para afrontarlos)

El tamaño de nervio óptico es pequeño, no es sospechoso para glaucoma, pero sí, la presión es alta mediados de los veinte. No pienso que funcione para usted este medicamento.

Quiero—

P: I also feel pressure in the eyes – como una presión adentro de los ojos – when I move down or look down.

Hijo: Ella te dice que la presión es tan alta-

P: Sí.. I understand.

D: It is possible with the pressure this high that you might feel uncomfortable or have head /eye pain with a change in body position. Es posible que tenga el dolor adentro de los ojos porque la presión es elevada.

Entonces quiero cambiar los medicamentos. I want to start different eye drops.

P: (asiente con la cabeza) Yes I agree. What should we do?

D: Tengo aquí muestras de dos otras marcas de gota para el glaucoma. En vez de latanoprost, la que tiene ahora- va a utilizar esta marca (le muestra a ella la otra) una gota por la noche, cada ojo. Y esta marca en el boxeo colorado rojo, una gota cada ojo dos veces al día. (le da los medicamentos a la paciente)

P: So I put this one at night, and this one morning and night, both eyes?

D: Yes. Then we’ll make an appointent for you to return, I’ll check the pressure on the new drops, and we’ll do another visual field test and photo of the optic nerve, to compare with those taken at your other doctor’s office.

Hijo: Ella quiere hacer una cita para revisar la presión después de utiliza estas gotas nuevas y para hacer examénes del nervio.

D: Sí para hacer un campo visual y sacar una foto del nervio óptico.

P: Yes, I understand what you’re saying.

D: (al dar a la paciente los boxeos de gotas y hoja de códigos) OK, puede entregar este papel en el frente para hacer la cita para la próxima vez. Hand in this sheet up front to make the appointment.

P + hijo: Gracias, doctora, dios le bendiga-

D: Igual, pasen ustedes un buen día.

Of note, this conversation took place with a Puerto Rican patient – she had just moved up to the U.S. and was in the process of switching over her medical care to local doctors. You can see the dialogue was a mix of English and Spanish. This type and level of mixed conversation never happens when I see patients from other Spanish-speaking regions of the world. I tend to see it more with the Puerto Rican patient population. I did some research online in this regard and found some interesting information regarding the reasons for this, mainly due to Puerto Rico’s political history. The island was initially claimed by Spain in 1493 and the language of the conquistadors prevailed. However, after the Spanish-American war, Puerto Rico joined the U.S. in 1898 and was granted citizenship in 1917. English began having a dominant influence.

Examples of Spanglish commonly encountered in the U.S. which have also infiltrated the island include:

el roofo = the roof (instead of azotea or techo)

parkear= to park (instead of estacionar)

la carpeta= the carpet (instead of alfombra; a confusing mistake, because carpeta in Spanish means folder)

el lonche= the lunch (instead of el almuerzo)

and a personal favorite of mine which I encountered as a doctor:

checkear= to check/toexamine (instead of revisar) – This one I caught myself using incorrectly for a long time based on what I heard patients say, until I looked up the true Spanish way of expressing “a check up” and found “una revisa” from “revisar”. Now I make it a point of saying it correctly.

Voynich Manuscript

BE the Interpreter

One day I was getting ready to call a patient from the waiting area  to begin his eye exam. He had marked “Spanish” as his preferred language on the intake forms, so I walked out to greet him.

He was sitting in the waiting area with a woman who looked about his age, and a younger man.  I called his name:

“Sr. Vasquez*, podemos empezar el examen ahora. Por favor, venga conmigo.”

*(names changed to protect patient privacy)

He got up and followed me, and the woman he was with stayed seated. But the young man stood up and trailed behind us toward the exam room.

I had just motioned for the patient to sit in the exam chair, when the patient’s ?friend ?family member reached the door.

“I’ve come to do the translation.”

I felt a twinge of irritation, but kept my composure,

“Oh, no es necesario – yo hablo español. Why? Is my Spanish that bad?”

The young man said “No!” and started laughing, and then I laughed, and then he turned and went back to the waiting area.

I shut the door and proceeded with the eye exam.

The truth is, if this man wanted to come into the room, or if the patient himself had insisted, I certainly would have allowed him to keep the patient company while I did the exam. It’s just, as I’ve said before many times in this blog, my attitude toward the use of Spanish during a medical exam runs a sinusoidal gamut of emotions, changing on any given day and even throughout the course of one day.

I go from feeling confident in my second language abilities, to being unsure. I feel frustration, at having to work harder, at having to think to communicate, and then there are the days when it’s easier and I’m more relaxed in my speech. At times I’m resentful, that out of the group of doctors where I work, I’m assigned all the Spanish –speaking patients while the other docs get to work comfortably in their native English. But almost simultaneously, I feel personal pride and a bit superior to these doctors, knowing I provide care in two languages. Knowing I am growing an ability and a talent that they lack, and it’s an ability that is not confined only to the exam room. Being able to communicate in Spanish – or, really, any language beyond our native one- widens our scope of interaction with the people around us. It broadens horizons. It enlarges our world. The other docs I work with live in a fish bowl. I’m sailing the high seas.

They say you have to push yourself outside your comfort zone to grow. Growth and change are uncomfortable. I have to remind myself of this constantly – when I get frustrated from forgetting a vocabulary word or from having to ask the patient to repeat himself more slowly so I can understand.  I have to remind myself that if I keep pushing ahead, what feels foreign will become second nature. Second nature means I can work more quickly and efficiently in Spanish.  And it really is to my advantage and to the advantage of my patient if I put in this extra effort.

There’s a poignant scene in an old Jim Carrey movie that I like, Bruce Almighty, that I’m reminded of at this time.  Morgan Freeman, aka God, endows his protégé Bruce (Jim Carrey) with all his powers.  Bruce takes the use of those powers to an extreme and to his advantage: walking on water, changing his beat-up old car into a sports car, dragging the moon closer to his house for a romantic evening, etc etc. But in the end, Freeman tells Bruce that all of his antics amount to nothing more than magic tricks. He tells Bruce, “You want a miracle? Be the Miracle!” After this Bruce, aka Jim Carrey, stops self-serving with these magical acts and instead simply reaches out and helps other people.

Similarly, I say, “You want an interpreter? Be the Interpreter!”  You want to communicate directly with your patient? You do the communication! So when my patient’s ?friend ?family member approached me and said,

“I’ve come to do the translation.” (he meant interpretation, but who’s mincing words?)

I just wanted to cut out the third party. Communication is clearer, faster and to-the-point when there is no middle man.

“No es necesario. Soy la traductora. Yo soy, la intérprete.”

2016 Adirondack Balloon Festival, Queensbury, NY

Una conversación con un paciente

Una conversación con un paciente is the title of a new series of blog entries that I am going to start this year. They represent real conversations I’ve had with patients over the course of my medical career. They provide a window into not only the doctor-patient relationship, but also a view into the culture, vocabulary and expressions specific to the Spanish-speaking patient. I will follow each dialogue with an English translation and, where applicable, an explanation regarding specific vocabulary or colloquial phrasing.

Dra.: Buenos días, hola, ¿Sra. - ? Es su turno, por favor, venga conmigo al cuarto de examinación.

Sra.: Hola, está bien.

Dra.: (enséñale a la silla) Por favor, siéntase ahí. Leí la información que la enfermera escribió aquí en su médico historial. Se dice que está aquí para un examen completo de los ojos, necesita lentes, pero tiene algunos problemas con los ojos...

Sra.: Sí.

Dra. Se dice que, a veces, tiene picazón de los ojos, y una sensación de “ojos cansados” o “ojos pesados”. Por favor, describa con sus propias palabras los síntomas exactos que tiene.

Sra.: Yes, bueno, particularmente por la mañana, cuando me levanto, es difícil abrir los ojos.

Dra. ¿Le echa gotas artificiales cuando esto le sucede?

Sra.: Sí, una vez al día, solo por la mañana. Esto me ayuda.

Dra. ¿Tiene los síntomas todas las mañanas cuando se levanta?

Sra.:  Más o menos, sí.

Dra. Bueno, voy a empezar el examen, y particularmente voy a enfocar en la capa de lágrimas. Es porque, generalmente con los síntomas que usted describe, el diagnóstico es sequedad de los ojos.

Sra.: (escuchar)

Dra.: Si eso es el caso, quiero que usted sepa que, puede utilizar – debe utilizar – las gotas artificiales con más frecuencia durante el día. Especialmente si tiene un trabajo donde mantiene una mirada fija en la pantalla de la computadora todo el día.

(dirige a la paciente a la lámpara de hendidura)

Sra.: (hablar durante el examen) ¿Dónde nació usted—dónde aprendió el español?

Dra.: Nací en Nueva York – lo aprendía durante los años académicos. Y claro, tengo mucha practica con los pacientes en la oficina. (sonreír)

Sra.: Nací en Puerto Rico, pero crecía en Brooklyn – mi inglés es mejor que el español, y pienso que su español sea mejor que el mío.

Dra.: (reír) Gracias –  siempre se puede mejorar, pero sí, tengo oportunidades para utilizar el idioma aquí. Otra vez, gracias.

(le da el tratamiento y las instrucciones a la paciente)

Sra.: ¿Con qué frecuencia debo hacerme otro examen de los ojos?

Dra.: Tiene ojos sanos, y no tiene un problema de salud, como por ejemplo la diabetes o la presión alta. Entonces, en su caso, debe volver cada uno o dos años – más pronto si hay un cambio de la visión.

Sra.: Está bien, bueno, gracias, muy amable. Pase un buen día.

Dra.: Igual, fue un placer conocerla. Hasta la próxima vez.

                                                                        *

Dr.: Good morning, hi, Mrs.--? It’s your turn, please, come with me to the exam room.

Mrs.-: Hi, OK.

Dr.: (motioning to the chair) Please, have a seat. I read the information the nurse wrote down in your medical record here. It says that you are here for a complete eye exam, that you need glasses, but you’re also having some problems with your eyes.

Mrs.-: Yes.

Dr.: It says that sometimes you have itchy eyes, and a sensation of “tired eyes” or “heavy eyes”. 

Please, describe in your own words the exact symptoms that you have.

Mrs.-: Yes, well, especially in the morning, when I get up, it is difficult to open my eyes.

Dr.: Did you try putting in artificial tears when that happens?

Mrs.-: Yes, one time a day, only in the morning. That does help me.

Dr.: Do you have symptoms every morning when you wake up?

Mrs.-: More or less, yes.

Dr.: Well, I’m going to begin the exam, particularly focusing on the tear film. This is because, generally with symptoms like those you describe, the diagnosis is dry eye.

Mrs.-: (listening)

Dr.: If that is the case, I want you to know that you can use – should use – the artificial tears more frequently during the day. Especially if you have a job where you keep a fixed stare at the computer screen all day.

(directs the patient to the slit lamp)

Mrs.-: (talking during the exam) Where were you born? Where did you learn Spanish?

Dr.: I was born in New York – I learned it during my school years. And, of course I have a lot of practice with the patients in the office (smiling).

Mrs.-: I was born in Puerto Rico, but I grew up in Brooklyn—my English is better than my Spanish, and I think your Spanish is better than mine.

Dr.: (laughing) Thank you. One can always improve, but yes, I have opportunities to use the language here. Thanks again.

(gives the treatment and instructions to the patient)

Mrs.-: How often should I come for an eye exam?

Dr.: You have healthy eyes, and you don’t have a health problem, like for example, diabetes or high blood pressure.  Then, in your case, you should return every one or two years, or sooner if there is a change in the vision.

Mrs.-: Ok, well, thank you, you’re very kind. Have a nice day.

Dr.: You are kind as well, it was a pleasure to meet you. Until next time..

                                                                        *

Noun Gender

As far as the written Spanish in this dialogue, one grammar rule I want to point out is that of a noun’s gender, is it masculine or feminine, and therefore should it be preceded by an ‘el’ or a ‘la’?  

In the case above when I write le da el tratamiento y las instrucciones a la paciente, I say “la paciente”.  

This is an interesting point, because there are some nouns we learn as masculine in Spanish, but have to adjust if the noun is used in reference to a female person.

In this conversation, my patient is a woman, so I would not say al paciente (as in a + el = al) rather, I would say  a la paciente.

Other examples of words treated in a similar way include: el/la superintendente and el/la gerente.

Courtesy: Clip Art Library

Small Wins, Small Losses

In my last blog entry, Mundane Details, I focused on how speaking Spanish with my patients has its good and bad days. There are the great days when I am able to communicate all of my thoughts very clearly and in turn, the patients understand me. Then there are the bad days, when my conversations are littered with grammar mistakes and I struggle to find the right interpretation. I used to think I was the only one who felt this way,  until I came across the blog of an American ex-pat in Spain who described similar frustrations.  It is comforting to know I’m not alone in this daily tug-of-war to get the language right.

Not long after completing that entry, and along this same vein of thought, I read a very interesting news article about a study that was done regarding unemployed workers.  Princeton economist Alan Krueger (who, incidentally, was chosen in 2001 by then President Barack Obama to chair the White House Council of Economic Advisors) interviewed over 6,000 unemployed workers for over half a year.  Up until this study was done and for the longest time, economists held the belief that when people lost their job, the longer they were out of work, the more vigorous their search for a new job would become. The thinking was that while a person remained unemployed, the absence of a paycheck and the accumulation of bills would spur a person into a greater frenzy to find a new position.  However, Mr. Krueger’s results actually refuted that belief. In fact, he found that the longer people are out of work, the less and less time they spend looking for a job. The reason? It all comes down to small wins and small losses, and their effect on the human psyche.

In the article, Alan Krueger, the Economics of Small Wins and Losses, written by Charles Duhigg,  Krueger explains that as a Cornell professor once appropriately stated in 1984, “Small wins are the steady application of a small advantage.” In other words, small wins (succeeding at something, overcoming a challenge, getting accepted for a job position, etc etc) give a person the confidence he or she needs to take the risk necessary to continue competing and continue moving forward. Small wins “..convince people that bigger achievements are within reach.”

However, just as an accumulation of wins encourages a person and imbues him with confidence, an accumulation of losses has the exact opposite effect. This is what was highlighted in Krueger’s study. As small losses mount up in a person’s life, “...people can become so sensitized to losses that they begin to anticipate them, and become less motivated to try.”  For example, experiencing the constant rejection of  job applications makes the applicant feel greater disappointment. Before long, the applicant begins anticipating rejection before it even happens. These losses have the power of reducing the job applicant's ability to even try to continue the search for employment. New coping mechanisms begin to develop: those of sleeping in later or taking numerous breaks from job hunting altogether.

After reading all of this, I had an epiphany: in many ways, the trials and tribulations one experiences while trying to communicate in a non-native language mimic the results of Alan Krueger’s study. I have said time and again during this blog that earlier on in my Spanish learning days, there were times I didn’t even want to start a conversation with someone in Spanish because I made a lot of mistakes. I was also afraid that I wouldn’t be able to understand the speaker. Either way I would (in my mind) come across looking foolish. This fear of looking or sounding foolish in Spanish made me not even want to try.

Today, things are different.  I have grown in the language- my vocabulary has expanded and I’ve had much more practice speaking and listening. Because I’ve experienced many more successful communications with patients, my confidence in the language has grown.  And it’s because my confidence has grown that I’m not as fearful when talking in Spanish because I know I’ll be able to express myself and, in turn, be able to figure out what the patient is saying. I still have a long way to go—there’s always room for improvement—but I’m much more proactive in Spanish than I was in the past.

 After Alan Krueger’s ground-breaking discovery of the power of small wins and losses, further studies were done by other investigators over the years as to what to do to solve the problem of overcoming the confidence lost from an accumulation of small losses. How can you encourage these disillusioned workers  to reignite their job search and instill confidence in themselves? How can a non-native language learner push herself to communicate when the grammar mistakes build? The answer: you have to reset expectations. In essence, you have to alter a perceived loss into an actual win. Take, for example, the workers in the above scenario.  When sending out a resume, the worker looks upon a callback for an interview as the win, so when he doesn’t get it, he feels he’s lost. If one resets the goal from a callback for an interview to simply sending out the resumes to as many potential employers as possible, then the act of successfully sending them out is the win. Callbacks are irrelevant.

When applying this to my speaking Spanish with patients, instead of me focusing on getting all the grammar and conjugation right, I should set the goal of simple understanding between doctor and patient. Maybe I’ll accidentally turn a feminine noun into a masculine one (potential loss, if I’m focusing on grammar as goal), but if the patient understands the point I was making (win! win! win!), then that’s the only goal that should matter.

As we transition from this eve of 2016 to 2017, let's not be afraid to take on new challenges in the face of failure or potential failure. If we're learning something and moving forward with that knowledge, then we have the potential to turn every 'loss' into a win. Happy New Year, everyone! 

References

Duhigg, Charles. “Alan Krueger, and the Economics of Small Wins (and Losses).” http://charlesduhigg.com/alan-krueger-and-the-economics-of-small-wins-and-losses/ (Accessed December 1, 2016).

Philips, Matthew. “Who is Alan B. Krueger?” Freakonomics. http://freakonomics.com/2011/08/29/who-is-alan-b-krueger/ 29 August 2011. (Accessed December 1, 2016).

Courtesy: Charles McDonald, Charlottesville Real Estate Solutions